The purpose of this study is to evaluate the ability of sirolimus to prevent graft versus host disease (GVHD) in patients following stem cell transplant from an unrelated donor. This trial is designed to test the hypothesis that elimination of methotrexate in the unrelated donor group would lead to less transplant-related toxicity while still preserving the effective control of GVHD.

To determine the feasibility of using a combination of sirolimus and tacrolimus without methotrexate for GVHD prophylaxis after stem cell transplantation.

Secondary Outcome Measures:

To compare the rates of grade II-IV and III-IV acute GVHD with historical control

to determine the incidence of 100 day mortality using this GVHD prophylaxis regimen

to determine the overall survival after one year of this patient population.

Estimated Enrollment:

30

Study Start Date:

November 2003

Study Completion Date:

June 2006

Primary Completion Date:

June 2006 (Final data collection date for primary outcome measure)

Detailed Description:

Therapy to prevent GVHD will consist of an infusion of tacrolimus intravenously and sirolimus orally once daily starting 3 days before stem cell infusion. This will take place in the hospital where the patient will remain for the duration of the transplant.

Sirolimus will continue for approximately 100 days at a stable dose, then it will be tapered slowly over the course of weeks to months to prevent a flare in GVHD.

Patients will be seen in the clinic weekly for the first 2 months after discharge from the hospital. If GVHD is present, tapering schedule will be slower and based on the patient's clinical condition.

Tacrolimus will also be given orally after the patient is discharged and will be tapered on the same schedule as sirolimus.

During the year following stem cell transplant, blood tests will be performed to evaluate the immune system and graft versus host disease.

Eligibility

Ages Eligible for Study:

18 Years to 55 Years (Adult)

Genders Eligible for Study:

Both

Accepts Healthy Volunteers:

No

Criteria

Inclusion Criteria:

Acute myelogenous leukemia(AML) in first or subsequent remission, in untreated first relapse or any treated relapse.

Acute lymphoblastic leukemia(ALL) in first or subsequent remission, in untreated first relapse or any treated relapse.

Chronic myelogenous leukemia in first or second chronic stable phase or in accelerated phase.

Myelodysplastic syndromes or myeloproliferative diseases

Non-Hodgkin's lymphoma or Hodgkin's disease in second or greater complete remission, in partial remission, or induction failure.

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Please refer to this study by its ClinicalTrials.gov identifier: NCT00144677